SALEM--The Oregon Health Authority has issued the following statement regarding the Secretary of State's audit report released today:
"The Oregon Health Authority (OHA) welcomes the Secretary of State's audit and its purpose to identify areas for improvement related to Medicaid payments. We look forward to implementing each recommendation from the audit team, and you can read about our detailed plans in our management response. One of OHA's most vital roles is to provide health coverage to vulnerable children and adults through the Oregon Health Plan (OHP). We see audits as an important tool to provide an outside point of view, strengthen our operations, and help us continue to fulfill our mission to OHP members and state taxpayers.
"The audit recognizes several existing, effective processes within OHA and includes several recommendations for improvement. While we agree with the final recommendations and have already begun implementing some of them, we do not agree with some of the audit team's estimates, underlying assumptions, and conclusions about Medicaid payments.
"For example:
-- We dispute the characterization of $88 million in payments to provide health coverage for 115,000 vulnerable children and adults as "avoidable." (In the wake of the Cover Oregon failure, federal officials approved delaying their eligibility renewals and were regularly briefed on Oregon's progress to renew them.)
-- We do not agree with the conclusion that the audit identified 31,300 "questionable" payments. A sample check of 2,700 of the transactions showed that more than 98 percent of these payments were appropriately paid.
"These and other points, are explained in more detail in the attached OHA response to the audit, which is available on the OHA website at http://www.oregon.gov/oha/HSD/OHP/Documents/OHA_Response_To_SOS_Medicaid_Payment_Audit.pdf.
"We appreciate the audit's recognition of Medicaid's complexity and scale:
-- The $88 million in "avoidable" state and federal expenses, as identified by the audit team, accounts for less than 1 percent of Oregon's annual $9.3 billion Medicaid budget.
-- The 31,300 "questionable" payments in the audit represent 0.06 percent of the more than 52 million payments OHA processes in a 15-month period.
-- The audit noted that the fee-for-service error rate in Oregon's Medicaid program (9 percent) is below the national average.
"While OHA has successfully expanded health coverage to more than 400,000 Oregonians and saved taxpayers $1.3 billion in health care costs, the effort to meet these challenges (as well as respond to the Cover Oregon failure) has not allowed us to build a foundation of consistent operational rigor and accountability in our Medicaid operations.
"We can do better. We are making changes to improve the accuracy and transparency of our programs:
-- A formal issues resolution process to identify, scope and solve operational problems in our Medicaid program.
-- A monitoring process to keep annual Medicaid eligibility renewals on track and ensure the ONE eligibility technology system continues to deliver more accurate and reliable results.
-- Adding staff capacity to strengthen our ability to hold providers and coordinated care organizations accountable and audit medical claims.
"These efforts will build on existing, effective tools the agency already uses for program integrity. We look forward to reporting on our progress to implement the recommendations of the audit and continue to improve our business practices."
-- Laura Robison, chief financial officer, OHA
OHA Director Patrick Allen and Robison will be available to take media questions regarding the audit at 12:30 p.m. today in Room 137 D of the Barbara Roberts Human Services Building, 500 Summer St. NE, in Salem.
Members of the media who plan to attend or need more information can contact strategic communications officer Saerom England at [email protected] or 971-239-6483.
November 29, 2017
